Healthcare Provider Details

I. General information

NPI: 1770150435
Provider Name (Legal Business Name): SHARON TENA CRENSHAW RADT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 NAPA VALLEJO HWY BLDG 253M1M2
NAPA CA
94558-6234
US

IV. Provider business mailing address

1215 MONTICELLO RD
NAPA CA
94558-2019
US

V. Phone/Fax

Practice location:
  • Phone: 707-255-8001
  • Fax: 707-255-8006
Mailing address:
  • Phone: 925-481-6942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number14767-RAC
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: